Managing the BPD Shotgun Effect

By Daniel Fox, PhD, author of The Borderline Personality Workbook

The borderline personality disorder (BPD) shotgun effect is when your client arrives for the first session, or the forty-second, and shoots all of this therapeutic content at the therapist, causing mutual feelings of being overwhelmed, helpless, frustrated, and confused. This causes stalling in the treatment progress, loss of valuable session time, missed opportunities for growth, and increased probability of premature termination. It’s possible to manage and control the BPD shotgun effect by distilling content and pairing it with your treatment trajectory and goals.

Controlling the BPD Shotgun Effect

Assess your own emotions and reactions; are you overwhelmed?

If yes, take a moment and re-center yourself with mindfulness and attention to your client’s thematic content.

Identify your client’s thematic content. Is it abandonment, emptiness, feeling worthless or invisible, loss of integrity, etc.?

Determine if this theme is a driving force for your client to engage in maladaptive patterns.

If it is, this is what is called “core content.” Core content drives surface-structure behavior, or maladaptive patterns (e.g., cutting, violence, self-sabotaging).

Now that you’ve identified the core content, ask yourself how this fits into the therapeutic trajectory for this client—your identified path to treatment goals.

At this stage, explicitly discuss your client’s core content and how it’s related to the client achieving their goals in treatment.

Now you’ve managed and significantly lessened the shotgun effect.

Return to step one as needed. This is not a “one-and-done” endeavor, but something to utilize on a continual basis with your clients.

Daniel J. Fox, PhD, is a licensed psychologist in Texas, an international speaker, and award-winning author. He has been specializing in the treatment and assessment of individuals with personality disorders for over fifteen years in the state and federal prison system, universities, and in private practice. His specialty areas include personality disorders, ethics, burnout prevention, and emotional intelligence.